{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:45:28Z","timestamp":1785545128078,"version":"3.56.0"},"reference-count":36,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Serious Games"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Amblyopia is a common cause of visual impairment in children. Compliance with traditional treatments for amblyopia is challenging due to negative psychosocial impacts. Recent shifts in amblyopia treatment have moved from suppressing the dominant eye to enhancing binocular visual function. Binocular digital therapy has become a promising approach.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n The aim of this study was to evaluate the effects of binocular gamified digital therapy on visual acuity and stereoacuity (SA) in children with unilateral amblyopia.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This pilot prospective study enrolled 11 children aged 4-6 years with unilateral amblyopia. Following at least 8 weeks of refractive correction, participants underwent binocular gamified digital therapy for 60 minutes per day, 5 days a week. The therapy used a roguelike shooting game delivered under binocular conditions through two independent channels with a real-time artificial intelligence visual engine. Assessments of distance visual acuity (DVA), near visual acuity (NVA), and SA were conducted at baseline and again at 4, 8, and 12 weeks.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n At 12 weeks, the following significant improvements were noted: amblyopic eye DVA improved by 1.0 line (\n P<\/jats:italic>\n =.01;\n d<\/jats:italic>\n =0.77), binocular DVA improved by 0.7 lines (\n P<\/jats:italic>\n =.006;\n d<\/jats:italic>\n =1.00), and SA improved by 0.3 logarithm (log) arcseconds (\n P<\/jats:italic>\n =.01;\n d<\/jats:italic>\n =0.97). At 8 weeks, improvements included amblyopic eye DVA by 0.9 lines (\n P<\/jats:italic>\n =.046;\n d<\/jats:italic>\n =1.00) and SA by 0.28 log arcseconds (\n P<\/jats:italic>\n =.02;\n d<\/jats:italic>\n =0.90). No significant adverse events were observed, although one participant developed progressive esotropia.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Binocular gamified digital therapy is effective and safe for improving visual outcomes in children aged 4-6 years with unilateral amblyopia.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/63384","type":"journal-article","created":{"date-parts":[[2025,1,17]],"date-time":"2025-01-17T04:36:38Z","timestamp":1737088598000},"page":"e63384-e63384","source":"Crossref","is-referenced-by-count":4,"title":["Transformative Gamified Binocular Therapy for Unilateral Amblyopia in Young Children: Pilot Prospective Efficacy and Safety Study"],"prefix":"10.2196","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4292-9507","authenticated-orcid":false,"given":"Wenqing","family":"Zhu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4734-6351","authenticated-orcid":false,"given":"Shuneng","family":"Gu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-2421-5890","authenticated-orcid":false,"given":"Jian","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-0114-778X","authenticated-orcid":false,"given":"Jin","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-3435-6935","authenticated-orcid":false,"given":"Chanling","family":"Hu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4092-2339","authenticated-orcid":false,"given":"Rui","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2025,1,16]]},"reference":[{"issue":"7","key":"R1","doi-asserted-by":"publisher","first-page":"1229","DOI":"10.1016\/j.ophtha.2007.08.001","article-title":"Prevalence of amblyopia and strabismus in African American and Hispanic children ages 6 to 72 months the multi-ethnic pediatric eye disease study","volume":"115","author":"Multi-ethnic Pediatric Eye Disease Study Group","journal-title":"Ophthalmology"},{"issue":"11","key":"R2","doi-asserted-by":"publisher","first-page":"2128","DOI":"10.1016\/j.ophtha.2009.04.034","article-title":"Prevalence of amblyopia and strabismus in White and African American children aged 6 through 71 months the Baltimore Pediatric Eye Disease Study","volume":"116","author":"Friedman","journal-title":"Ophthalmology"},{"issue":"10","key":"R3","doi-asserted-by":"publisher","first-page":"2117","DOI":"10.1016\/j.ophtha.2013.03.001","article-title":"Prevalence of amblyopia or strabismus in Asian and non-Hispanic White preschool children: multi-ethnic pediatric eye disease study","volume":"120","author":"McKean-Cowdin","journal-title":"Ophthalmology"},{"issue":"11","key":"R4","doi-asserted-by":"publisher","first-page":"2262","DOI":"10.1016\/j.ophtha.2011.06.033","article-title":"Risk factors for decreased visual acuity in preschool children: the multi-ethnic pediatric eye disease and Baltimore pediatric eye disease studies","volume":"118","author":"Tarczy-Hornoch","journal-title":"Ophthalmology"},{"issue":"11","key":"R5","first-page":"1624","volume":"26","author":"Birch","journal-title":"Invest Ophthalmol Vis Sci"},{"issue":"1","key":"R6","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1016\/j.ajo.2006.09.027","article-title":"Anisometropic amblyopia treated with spectacle correction alone: possible factors predicting success and time to start patching","volume":"143","author":"Chen","journal-title":"Am J Ophthalmol"},{"issue":"6","key":"R7","doi-asserted-by":"publisher","first-page":"895","DOI":"10.1016\/j.ophtha.2006.01.068","article-title":"Treatment of anisometropic amblyopia in children with refractive correction","volume":"113","author":"Cotter","journal-title":"Ophthalmology"},{"issue":"11","key":"R8","doi-asserted-by":"publisher","first-page":"2075","DOI":"10.1016\/j.ophtha.2003.08.001","article-title":"A randomized trial of prescribed patching regimens for treatment of severe amblyopia in children","volume":"110","author":"Holmes","journal-title":"Ophthalmology"},{"issue":"9","key":"R9","doi-asserted-by":"publisher","first-page":"990","DOI":"10.1001\/jamaophthalmol.2021.2413","article-title":"Effect of combined atropine and patching vs patching alone for treatment of severe amblyopia in children aged 3 to 12 years: a randomized clinical trial","volume":"139","author":"Wang","journal-title":"JAMA Ophthalmol"},{"issue":"5","key":"R10","doi-asserted-by":"publisher","first-page":"429","DOI":"10.1016\/j.jaapos.2003.09.005","article-title":"Risk factors for treatment failure of anisometropic amblyopia","volume":"8","author":"Hussein","journal-title":"J AAPOS"},{"issue":"2","key":"R11","doi-asserted-by":"publisher","first-page":"594","DOI":"10.1167\/iovs.07-0869","article-title":"The effect of amblyopia on fine motor skills in children","volume":"49","author":"Webber","journal-title":"Invest Ophthalmol Vis Sci"},{"issue":"7","key":"R12","doi-asserted-by":"publisher","first-page":"3502","DOI":"10.1167\/iovs.09-4236","article-title":"Reading strategies in mild to moderate strabismic amblyopia: an eye movement investigation","volume":"51","author":"Kanonidou","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"R13","doi-asserted-by":"publisher","DOI":"10.1016\/j.exer.2018.07.013","article-title":"Fixation instability during binocular viewing in anisometropic and strabismic children","volume":"183","author":"Kelly","journal-title":"Exp Eye Res"},{"issue":"11","key":"R14","doi-asserted-by":"publisher","first-page":"1074","DOI":"10.1097\/OPX.0b013e31818b9911","article-title":"Effect of amblyopia on self-esteem in children","volume":"85","author":"Webber","journal-title":"Optom Vis Sci"},{"issue":"6","key":"R15","doi-asserted-by":"publisher","first-page":"793","DOI":"10.3233\/RNN-2010-0550","article-title":"A new binocular approach to the treatment of amblyopia in adults well beyond the critical period of visual development","volume":"28","author":"Hess","journal-title":"Restor Neurol Neurosci"},{"issue":"2","key":"R16","doi-asserted-by":"publisher","first-page":"817","DOI":"10.1167\/iovs.11-8219","article-title":"An exploratory study: prolonged periods of binocular stimulation can provide an effective treatment for childhood amblyopia","volume":"53","author":"Knox","journal-title":"Invest Ophthalmol Vis Sci"},{"issue":"11","key":"R17","doi-asserted-by":"publisher","first-page":"5332","DOI":"10.1167\/iovs.07-0194","article-title":"Binocular summation of contrast remains intact in strabismic amblyopia","volume":"48","author":"Baker","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"R18","doi-asserted-by":"publisher","DOI":"10.1016\/j.visres.2015.02.009","article-title":"Amblyopia and the binocular approach to its therapy","volume":"114","author":"Hess","journal-title":"Vis Res"},{"key":"R19","doi-asserted-by":"publisher","DOI":"10.2196\/32282","article-title":"Gamification to support adherence to a therapeutic ambylopia treatment for children: retrospective study using a focal ambient visual acuity stimulation game","volume":"6","author":"Bocqu\u00e9","journal-title":"JMIR Pediatr Parent"},{"issue":"2","key":"R20","doi-asserted-by":"publisher","DOI":"10.2196\/34756","article-title":"Interactive digital game for improving visual-perceptual defects in children with a developmental disability: randomized controlled trial","volume":"10","author":"Wu","journal-title":"JMIR Serious Games"},{"issue":"11","key":"R21","doi-asserted-by":"publisher","first-page":"2076","DOI":"10.1016\/j.ophtha.2004.04.032","article-title":"A randomized trial of atropine regimens for treatment of moderate amblyopia in children","volume":"111","author":"Repka","journal-title":"Ophthalmology"},{"issue":"3","key":"R22","doi-asserted-by":"publisher","first-page":"160","DOI":"10.1016\/j.jaapos.2019.02.007","article-title":"Binocular amblyopia treatment with contrast-rebalanced movies","volume":"23","author":"Birch","journal-title":"J AAPOS"},{"issue":"11","key":"R23","doi-asserted-by":"publisher","first-page":"1511","DOI":"10.1136\/bjophthalmol-2015-307798","article-title":"Randomised controlled trial of video clips and interactive games to improve vision in children with amblyopia using the I-BiT system","volume":"100","author":"Herbison","journal-title":"Br J Ophthalmol"},{"issue":"4","key":"R24","doi-asserted-by":"publisher","first-page":"217","DOI":"10.1016\/j.jaapos.2021.03.008","article-title":"Virtual reality prototype for binocular therapy in older children and adults with amblyopia","volume":"25","author":"Elhusseiny","journal-title":"J AAPOS"},{"issue":"1","key":"R25","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1016\/j.ophtha.2021.09.001","article-title":"Randomized controlled trial of a dichoptic digital therapeutic for amblyopia","volume":"129","author":"Xiao","journal-title":"Ophthalmology"},{"issue":"3","key":"R26","doi-asserted-by":"publisher","first-page":"274","DOI":"10.1016\/j.ophtha.2022.10.020","article-title":"An eye-tracking-based dichoptic home treatment for amblyopia: a multicenter randomized clinical trial","volume":"130","author":"Wygnanski-Jaffe","journal-title":"Ophthalmology"},{"issue":"8","key":"R27","doi-asserted-by":"publisher","first-page":"761","DOI":"10.1080\/08820538.2023.2223275","article-title":"A prospective trial to assess the efficacy of eye-tracking-based binocular treatment versus patching for children\u2019s amblyopia: a pilot study","volume":"38","author":"Zhu","journal-title":"Semin Ophthalmol"},{"issue":"9","key":"R28","doi-asserted-by":"publisher","first-page":"697","DOI":"10.1097\/OPX.0b013e3181ea18e9","article-title":"A binocular approach to treating amblyopia: antisuppression therapy","volume":"87","author":"Hess","journal-title":"Optom Vis Sci"},{"issue":"2","key":"R29","doi-asserted-by":"publisher","first-page":"166","DOI":"10.1016\/j.jaapos.2012.10.021","article-title":"The effect of amblyopia treatment on stereoacuity","volume":"17","author":"Stewart","journal-title":"J AAPOS"},{"issue":"12","key":"R30","doi-asserted-by":"publisher","first-page":"1402","DOI":"10.1001\/jamaophthalmol.2016.4224","article-title":"Binocular iPad game vs patching for treatment of amblyopia in children: a randomized clinical trial","volume":"134","author":"Kelly","journal-title":"JAMA Ophthalmol"},{"issue":"6","key":"R31","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1167\/iovs.61.6.50","article-title":"Suppression rather than visual acuity loss limits stereoacuity in amblyopia","volume":"61","author":"Webber","journal-title":"Invest Ophthalmol Vis Sci"},{"issue":"12","key":"R32","doi-asserted-by":"publisher","first-page":"1391","DOI":"10.1001\/jamaophthalmol.2016.4262","article-title":"Effect of a binocular iPad game vs part-time patching in children aged 5 to 12 years with amblyopia: a randomized clinical trial","volume":"134","author":"Holmes","journal-title":"JAMA Ophthalmol"},{"issue":"2","key":"R33","doi-asserted-by":"publisher","first-page":"172","DOI":"10.1001\/jamaophthalmol.2017.6090","article-title":"Effectiveness of a binocular video game vs placebo video game for improving visual functions in older children, teenagers, and adults with amblyopia: a randomized clinical trial","volume":"136","author":"Gao","journal-title":"JAMA Ophthalmol"},{"issue":"3","key":"R34","doi-asserted-by":"publisher","first-page":"456","DOI":"10.1016\/j.ophtha.2018.10.032","article-title":"A randomized trial of binocular Dig Rush game treatment for amblyopia in children aged 7 to 12 years","volume":"126","author":"Pediatric Eye Disease Investigator Group","journal-title":"Ophthalmology"},{"key":"R35","doi-asserted-by":"publisher","DOI":"10.1016\/j.visres.2018.04.005","article-title":"An action video game for the treatment of amblyopia in children: a feasibility study","volume":"148","author":"Gambacorta","journal-title":"Vis Res"},{"issue":"2","key":"R36","doi-asserted-by":"publisher","first-page":"281","DOI":"10.1016\/j.ophtha.2008.09.012","article-title":"Defining real change in measures of stereoacuity","volume":"116","author":"Adams","journal-title":"Ophthalmology"}],"container-title":["JMIR Serious Games"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/games.jmir.org\/2025\/1\/e63384","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T22:31:05Z","timestamp":1785537065000},"score":1,"resource":{"primary":{"URL":"https:\/\/games.jmir.org\/2025\/1\/e63384"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,16]]},"references-count":36,"URL":"https:\/\/doi.org\/10.2196\/63384","relation":{},"ISSN":["2291-9279"],"issn-type":[{"value":"2291-9279","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,16]]},"article-number":"v13i7e63384"}}